Provider Demographics
NPI:1184008161
Name:J10 INTERNATIONAL
Entity Type:Organization
Organization Name:J10 INTERNATIONAL
Other - Org Name:ONE TEAM ONE FIGHT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-885-0082
Mailing Address - Street 1:1001 PAT BOOKER RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-4154
Mailing Address - Country:US
Mailing Address - Phone:210-885-0082
Mailing Address - Fax:
Practice Address - Street 1:1001 PAT BOOKER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4154
Practice Address - Country:US
Practice Address - Phone:210-885-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70567251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management